Management of Steroid-Induced Osteoporosis

Chronic use of corticosteroid is the most common secondary cause of osteoporosis. Contrary to previous belief apart from the primary or the idiopathic type, it occurs in all racial groups, both genders, and at any age. In a large cross sectional study in which 229 corticosteroid users (mean age 61 years, ≥6 months of prednisone, ≥5 mg/day) were compared with 286 controls not taking corticosteroids, the prevalence of vertebral fracture was 28% in corticosteroid users and 11% had two or more fractures. The risk factors for fractures were age, which was a strong independent predictor than bone mineral density.1 Corticosteroid induced bone loss can occur early. Available data suggest that vertebral bone loss with corticosteroid can occur as early as in the first 20 weeks in patients with rheumatoid arthritis (RA) on prednisone with a dose of 10 mg daily. Interestingly, upon stopping corticosteroid therapy, the trabecular bone loss can partially be reversed.2 While it is true that bone loss in early RA may be due to uncontrolled disease activity and corticosteroid may actually be beneficial, this effect might not offset the detrimental effects of corticosteroids on bone.3